Our Feel-Good War on Breast Cancer

Peggy Orenstein has a hell of a piece in the New York Times magazine on "pink ribbon culture," and her frustration (which, as a woman with breast cancer, I fervently share) about how much progress has been made:

Scientific progress is erratic, unpredictable. “We are all foundering around in the dark,” said Peter B. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center. “The one thing I can tell you is some of that foundering has borne fruit.” There are the few therapies, he said — like tamoxifen and Herceptin — that target specific tumor characteristics, and newer tests that estimate the chance of recurrence in estrogen-positive cancers, allowing lower-risk women to skip chemotherapy. “That’s not curing cancer,” Bach said, “but it’s progress. And yes, it’s slow.”

The idea that there could be one solution to breast cancer — screening, early detection, some universal cure — is certainly appealing. All of us — those who fear the disease, those who live with it, our friends and families, the corporations who swathe themselves in pink — wish it were true. Wearing a bracelet, sporting a ribbon, running a race or buying a pink blender expresses our hopes, and that feels good, even virtuous. But making a difference is more complicated than that.

Read: "Our Feel-Good War on Breast Cancer" [NYTimes.com]


  1. I’ve only glanced through this, but it looks like a very good summation of the reality of the disease(s) and how wildly successful marketing efforts have trumped medical fact in a number of aspects. A friend of mine who’s a medical librarian has told me that she is very, very careful about talking about some of these things, such as the best evidence regarding mammograms, even to medical professionals who should know better; her hospital is in a community with a very strong Susan G. Komen chapter. 

  2. It is tragic, as there seems to be a huge amount of support for the cause, and not just as a ‘feel good’ measure. There’s a desperation about seeing cancer as a game of  numbers, and frustration with seeing so little progress, relatively speaking. Unfortunately, those movements with the greatest focus on awareness will tend to achieve their aim, while providing relatively little to benefit those who are suffering from cancer (or who will suffer from it in the future). The idea that not having a mammogram or undergoing other kinds of treatment might be better than having one is also difficult, as the idea of having cancer is too unthinkable not to do whatever is in your power to prevent it. My wife has a family history of breast cancer, so I’m dreading hearing the news that it’s become more than just theory in our case.

  3. Setting aside the pink ribbons, take 5-year survival, for example, the most-often used stat to show our march towards an inevitable cure.  With the increase in sensitivity of imaging, and increase in frequency of use of imaging, breast cancers are being detected earlier and earlier.  So, now we are finding stage 1 and 2 cancers that 10 or 20 years ago we would only find at stage 2, 3 or 4.  What do you think this does to the stat? Of COURSE it pumps up the stat.  Of COURSE 5-year survival is better now: we have a running start.  Months if not years more lead-time by catching cancers early.  But the outcomes are just as bad, if not worse than ever.  Early detection is touted as this wonderful thing.  It has been marketed and marketed as the solution.  But the boots-on-the-ground reality is that cancer mortality is still awful.  http://cbcrp.org/publications/papers/mayer/page_08.php

    What we need are BETTER TREATMENTS.  The way to get them is to improve research.  Not just more money, but targeted, concerted effort.  If we can build nuclear bombs and stage multi-trillion-dollar war after war, we can build a cancer study infrastructure that actually achieves something.

    1. But you see, we’re busy waging multi-trillion-dollar wars. We don’t have time for cancer.

  4. I think there’s another component that isn’t being considered: our environment (in the largest sense of the word).

    Despite awareness, early detection, and having more (and more targeted) ways to treat specific cancers, our survival rates aren’t dropping.  What if we’re merely running in place with our treatments because our air, water, food, packaging, etc. are all working against us?

    In other words, has there been a study somewhere “pristine”, where we could measure how well early detection and treatment actually work when not hampered by the ongoing onslaught of modern industrialized life?

    It could be that early detection and treatment are masking what would otherwise be significantly *higher* rates of cancer (and cancer-related deaths) in our population these days.

    1. This is confusing to me.  Rates of cancer survival (increasing) and rates of cancer (decreasing) are two separate things.  You could increase the rates of survival to 100% without affecting the rate of cancer, itself. 

      How could more early detection mask an increase in cancer rates? Is there any evidence that rates of cancer are not decreasing?

      1. The article talks specifically about rates of breast cancer survival NOT increasing despite early detection and treatment.

        Where are you getting the idea that rates of cancer are decreasing?

        1. I mistakenly was talking about all cancer, not breast cancer, which the article and this thread are about.  Sorry about that.

          Also doubly sorry, because it turns out that cancer rates are slightly decreasing in men (.6 percent per year 00-09), holding steady for women, and slightly increasing in kids (.6 % per year 00-09).  


          All of which seems like less of a decrease and more of a holding steady.  So, I’ll just be quiet now.

          1.  No, it’s good to ask questions. You made me think about what I’d said and how your response might make me have to change my understanding.

          2.  Read dioptase’s response, below.  That post gets it right.  Cancer is such a vague term.  There are so many cancers, so many types of cancers in a category.  We really should be treating them like separate diseases, rather than lumping them all together as “cancer” or even as “breast cancer”.  Those categories do an injustice to the advances or failures of treatments and screening.

          3. A lot of the decrease is long-term effects of reduced tobacco smoking, as well as some improvements in cancer treatment and increased colon cancer screening and colonoscopies.  HPV-related cancers are still on the increase, even though vaccination will eventually reduce the HPV epidemic.

  5. People speak of cancer as if it were A disease.  Singular.  Even breast cancer is talked about like it was one disease.  That confuses the whole issue.  In reality, there are hundreds of different cancers and many types of breast cancer.  Each has it own characteristics, problems, and weaknesses.  And while they share some common features, they share many more features with healthy tissue.

    Some cancers have been cured.  Just as we’ve eliminated the threat from some viruses and bacteria.  Some cancers can now be managed as a chronic disease, just like some viruses and bacteria.  Others cancers and pathogens are still beyond our understanding or control.  On the spectrum of cancer treatment progress, breast cancer is relatively better treated than most.

    Unfortunately we’ve done a disservice to women.  In promoting breast cancer testing and research, we’ve made a generation terrified of their bodies and scared of the diagnosis.  Yeah, it’s serious.  But it’s not as common or deadly or untreatable as other forms of cancer.  We need to leaven the discussion with some hope and compassion instead of more fear geared to raising more money.

    1. Plus breast cancer is being singled out as if you can just focus on that.  It is likely that addressing breast cancer will require understand all cancers.  We’ll need to understand the multiple paths that can lead to it, cellular signaling, etc.

  6. I really hate the Avon Walk foundation’s slogan:

    “The more of us who walk, the more of us survive”

    Aside from the somewhat tortured grammar, it just seems so false. It really tries to make you buy into the idea that going for a walk will save an extra person.

    They do donate millions, so I certainly think that’s good (although much has been written on the cost/benefits of having expensive well-advertised walks for charity). I guess if the simplistic nature of the slogan does significantly generate more money for cancer research and for providing care to low-income patients, then that’s great. It still seems weird to have the slogan be such a simplistic platitude, though.

    1. They weren’t the first to use that slogan.  It was put to effective use by the Israelites, in Bataan, and in Birmingham.  One has to wonder how effective it would have been if it had been used as a fundraiser instead.

  7. As a physician i think this is a terrific article that generates more questions than answers. Most of the questions are of both sociological and scientific nature:
    Is the quintessential American winner/loser approach the right one when it comes to cancer ( or other serious medical conditions ) ?  I personally feel that the war/battle approach towards disease can sometimes be counterproductive , especially with serious chronic conditions, and that the more serene/resilient -and, why not? at times   in denial-  patient may do better in the long run than the “fighter”.

    1. Yes, this whole notion of “fighting cancer” is somewhat misguided.  How could a doctor say to a patient, “OK, now you really gotta FIGHT THIS.”    (huh? what does that mean?)  Of course a patient is gonna fight.  The non-fighters don’t seek treatment.  But there is another way that you suggest: a more personal journey of getting treatment, trying to do the best, maintain life, maintain mental health, and live fully in spite of the cancer.  All this fight talk, while comforting to (some) egos, is probably counterproductive.  Good post, Doc!

    2. Well, as long as we get plenty of prayer warriors involved, I’m sure things will make a turn for the better.

      Admittedly, I’m veering off on a radical tangent, but your comment about the American war/battle approach stirred up my ire again about how fiercely (rimshot) Evangelicals latch onto and buy into this mindset.

      I can’t reconcile the idea of faith and prayer with bloody battle. Somehow, I can’t help feeling that the very same people who probably fervently sported those “WWJD” bracelets haven’t truly thought much about the rhetorical question they pose.

      Certainly to each his own, but my concept of striving to live a Christian life – or a healthy life – isn’t couched in antithetical violent references.

  8. That was a long, long, long read. I’m a fast reader typically but even so, it took me awhile.

    That said, I’m really glad I read it. So much new information I never knew and/or considered. Thank you for sharing it.

  9. “For all the hundreds of billions of dollars that they raise for cancer research, it’s never going to amount to anything. […] Someone very astutely said “Trying to find the answer to cancer by studying individual cell is like trying to understand traffic jam by studying the internal combustion engine.”” – Gabor Mate

    Source: http://youtu.be/rYbeyU3pQvI?t=12m13s 12:13

    1. I have a lot of respect for Gabor Mate, and attend closely to anything he cares to talk about.  I’m bound to see the world a little more clearly and compassionately for having done so.

    2. With all due respect to Dr Maté, he’s a well-read doctor, not a cancer scientist. I really hate it when an outside looks at an entire field, of thousands of scientists, and says “oh no, they’re all doing it wrong, I know better.”

      Sure there’s a holistic aspect to cancer, and there are scientists studying it. There is also a very large aspect of cancer that has to do with why an individual cell behaves the way it does, and many other scientists are studying that. All of this has and will continue to create treatments for cancer. Many cancer patients can now put cancer into remission for decades — that wasn’t the case 20 years ago.

      To say that basic research “is never going to amount to anything” is just nonsense.

      1. I can see that you’re upset because you perceive that quote is  invalidating current research. I see it may be a bit out of context. The point was that looking for the causes of cancer requires taking more variables into account.

    1. This kind of thing is far worse than pinkwashing in my book. Acting like you’re on the same side as breast cancer sufferers because they are going through heartbreaking and painful operations on their breasts as well as facing possible mastectomies, chemo, bankruptcy and death, while you like looking at their breasts is just jaw dropping. The fact that a lot of the income and “awareness” will go to the photographer rather than the victims just adds that extra touch of exploitation to the mix.

  10. Another basic problem is the way the US cancer registries are set up. Cancer registry data, captures data at the time
    of diagnosis and death. It doesn’t track what happens in between.

    As Orenstein notes, 30% of those originally diagnosed with early stage breast cancer will have a metastatic recurrence. But this information is not tracked–until their deaths.

    NCI and SEER database record  incidence, initial treatment and mortality
    data. Most people do
    NOT present with metastatic diagnosis. The cancer registry does not
    track recurrence—which is how the majority of people are thrust into the
    metastatic breast cancer ranks.

    We really have no idea what’s going on with the MAJORITY
    of people who are diagnosed with metastatic breast cancer after a
    recurrence. (No one dies from early stage breast cancer–they die when the cancer spreads beyond the breast, to bone, liver, lung, brain or some combination therein)

    We say that there are 150,000 US people currently living with metastatic breast cancer, but that’s basically a guess.

    We know for sure that 40,000 US people die from breast
    cancer every year. We know that 5 to10 percent of those with metastatic
    breast cancer were Stage IV from their first diagnosis like me. So what about
    the 90 to 95% of those 150,000 currently living with metastatic breast cancer  who were previously treated for early stage breast cancer? The cancer
    registry does not track them—until they die.

    You can’t manage what you don’t measure.

    Katherine O’Brien
    Metastatic Breast Cancer Network


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